Amazon has had drug problems in the past...

http://www.slate.com/articles/health_and_science/medical_exa...

https://abcnews.go.com/amp/Health/amazon-prescription-drug-p...

Everyone knows pharmacies are highly regulated, however Amazon has somehow managed to flaunt regulations so far without much consequences.

I’ll grant you it is worrying to see that happening, interesting articles I had no idea about. Though I would think now that Amazon is officially getting into the pharmaceutical game, this will bring them under much more scrutiny for this kind of thing in the future.

I could be wrong, as the first article states, Amazon skated by without so much as a warning while bodybuilding.com had to pay fines for selling the same steroids, but I would expect the FDA is able to throw their weight around more with Amazon now by shutting down their official pharmaceutical operation if they continue to make perscription medications available like this on their retail site.

> In a pharmacy, medications are NEVER allowed to be commingled. If your medication is coming from two different manufacturers, or even the same manufacturer but the pills just look different, the pharmacy must put them in two different bottles to give to you

Are there any exceptions allowed? I'm pretty sure I've had a major nationwide pharmacy give me a bottle with pills from two manufacturers in it. It had pills from the first in the bottom of the bottle, then a cotton wad on top of those, and the pills from the second manufacture on top of the cotton ball.

They opened the bottle when I went to pick it up, and pointed out what was going on inside and made sure I understood. They explained that they did not have enough pills in stock from the manufacturer they had used before for that prescription and refills, so filled out the order from a different manufacturer.

Perhaps it does not count as commingling because they divided the bottle into separate champers with a wad of cotton?

Pharmacy is regulated state by state. What they did may be ok in that state, or may be marginally ok. At the least, they didn’t just dump them into the same bottle together.

I don't know why you're getting downvoted. I've had the same thing happen multiple times, also at a certain "major nationwide pharmacy." Interestingly, the smaller/more local pharmacies have never done this.

I can attest to this. I recently got 2 bottles of seemingly identical muscle relaxers, but they were just two diff manufacturers. And they made a point of calling it out so i knew why i got two half filled bottles..

Was also going to mention the same. Amazon will buy directly from the manufacturer.

What always seemed odd to me in such a wasteful society as the US: counting pills. Really? In many countries you get blisters. No counting. I suspect in some European countries it would actually be illegal to do this.

The disadvantage is that there are some leftover pills most of the time. E.g. you need 30 pills and there are only units of 20 available.

In New Zealand, I sometimes receive prescription medication in a generic box full of blister packs, where the last blister pack has been cut down to match the prescribed number of doses. Occasionally I'll get a couple of cut down sheets, presumably using up the leftovers from other people's prescriptions.

> The disadvantage is that there are some leftover pills most of the time. E.g. you need 30 pills and there are only units of 20 available.

This is the exact reason why they count pills. You have a prescription for X pills, you get X pills.

It's been a while since I've had a prescription filled, but I think that in New Zealand it's the same. Most prescription drugs like opiate painkillers or antibiotics are counted and bottled.

Here in India, they'll either cut the blisters to your prescription or give already cut blisters from previous orders.

Yes, but is it worth the trouble?

Also, you may be able to build robots to dispense pills. But have you seen a European automated pharmacy supplier? Everything is automated. They dispense all the blister packs into a small cart that gets delivered to the pharmacy. In the end it does not matter if you supply a pharmacy with 2-20 medicines or a consumer with 1-10.

  Yes, but is it worth the trouble?

The "schedule II drugs" jeherr mentions as being counted twice are things like cocaine, methamphetamine and fentanyl. i.e. drugs that could be readily sold onto the black market.

While cocaine and methamphetamine are schedule II, those are poor examples. I don’t think pharmacies ever carry them, and their medical use is very rare.

Fentanyl is commonly carried in pharmacies but it’s not a commonly prescribed medication. Better examples would be adderall, vyvanse, norco and oxycontin.

I used to work at a mail order pharmacy. Even though a machine counted the pills a pharmacist had to certify every bottle. This amounted to bottles coming down a conveyor and the pharmacist picking each one up, scanning it, and looking at a picture of the pills on a screen to make sure they are the same. I wouldn’t doubt if Amazon would need to do the same were they to use individual pill counts.

It's the much superior way to do it though, in France all estimate say we would save a lot of money by doing this, but with such a strong phamaceutical lobby it just never happens. Same reason why somehow we have homeopathy being reimbursed as if it was a real medicine, Boiron is french !

Clearly the parent commenter didn't intend to imply that the industry is not regulated. I think it was more of a tongue-in-cheek jab at Amazon.

I think it's just generally weird that a shipping and commerce company is taking interest in pharma to begin with. I think it SHOULD make users uncomfortable that a single company is potentially exposed to all these different vertices of user information. They know what you buy, soon they'll know what groceries people buy, what they read, what medicine they take which could in turn reveal metadata like sexual habits or genetic patterns.

It's weird.

Is it weird?

I feel like it's more like Amazon just trying to monopolize everything. There are articles out there talking about getting Amazon-ed. Where Amazon would go in your industry and dominate you out the market. (https://www.forbes.com/sites/jamescahn/2018/04/24/dont-let-y...)

This is just a natural thing or the thing that Amazon does. Their modus operandi.

> what medicine they take which could in turn reveal metadata like sexual habits

They do recommendation system and I believe they sell sex toys so yeah... Alexia knows your kink already.

It's not weird but I think the better question is is this okay for one company to have so much power in so many area. Or at least I believe that's what you are trying to convey.

I guess I meant weird in the moral sense. It's certainly not unusual given their past behavior as a corp.

Sort of depressing, really.

That kind of "innovation" is just what I've come to expect from Amazon.

What part of heavily regulated is hard to understand? The Amazon Marketplace is regulated by Amazon. Pharmaceuticals are regulated by the FDA.

Not just the FDA, but also the DEA and the states Board of Pharmacy.

> When a prescriptions for a schedule II drug is filled, the pharmacy technician has to count the number of pills being filled twice. Then the pharmacist has to count the number of pills, and then backcount the stock bottle to make sure everything is kosher and no pills are missing.

Good grace. What a load of unnecessary bureaucracy.

In the modern world medicines come in pre-counted blister packs where there is zero room for error. Here in America we have to wait around an hour for some dolt to count and then double count the pills.

That's dramatically overblown and incorrect (and rather insulting to trained professionals whom you apparently know nothing about). Many perscription drigs do come in blister packs in the US, but you may not have seen them because it's generally only the ones that are nearly always perscribed in the same amount - a Zithromax Z-Pack for example.

Any other medication coming in blister packs wouldn't change a darned thing, unless you expect pharmacies to carry large quantities of sealed 5,10,15,20 etc etc dose packs. If they didn't, they'd still be breaking the sealed packs up and counting to match the perscribed amount.

Actually, it changes things quite a bit. The pharmacist ends up doing some basic math for each script instead of counting pills. Italy does this pre-counted system and getting a script filled takes seconds instead of dozens of minutes.

It is pretty remarkable how inefficient getting pills from a pharmacist is. The actual dispensing could be easily handled by a glorified vending machine so all the pharmacist would have to do is punch some buttons on a computer instead of having to physically handle anything except dumping packages from the manufacturer in it upon delivery.

Actually, some pharmacies do have counting robots now which count out their most commonly filled prescriptions, like norco. They’re not perfect though.

Who do you complain to when the robot shorts you? Unless most doctors are writing scripts for noncomposite amounts of pills this needs to be simpler. Boxes of 15 can turn into 60, 90, 120, etc.

Very common now. All the pharmacies in my primary health system's offices use these: https://innovat.com/pharmassist-robotx/

Why make a human type it in if the majority of scripts are coming in via E-prescription?

Baby steps...in order for that to work there'd have to be some kind of interoperable API standard adopted by all doctors in pharmacies that the system understands (I am assuming there is not). In an ideal world there'd be basically no humans involved as soon as the doctor prescribes, obviously...

What makes you think an ideal world would involve no humans after the doctor writes a prescription? There’s a very good reason we have pharmacists. Doctors can and do make mistakes, and they may not know every medication that a patient is taking. Somebody has to catch these mistakes and potentially lethal interactions.

Doctors are typically not experts in medications. Specialists probably know a lot about medications pertaining to their specialty, but asking GPs to know so much about a vast array of diseases AND the medications to treat them all, AND all interactions between medications is unreasonable. Doctors education is primarily in diagnosing disease. Pharmacists go to school just as long as doctors do (I think the major difference is pharmacists don’t typically do a residency after they graduate unless they are not planning to work in a community pharmacy), but their entire education is based around medications. Pharmacists are the medication experts. It’s a good thing that we have both looking after the healthcare of patients.

Hence why I said "ideal"...